Saturday, November 2, 2013

How to Study in Medical School

In an older post, I wrote a little bit about my search for efficient study tools for medical
school, and how I eventually discovered Anki and OneNote. To briefly summarize,
I spent part of the summer before school started trying to figure out how I was
going to study. I knew it would be a different ballgame than undergrad (and
that turned out to be true), so I figured my old methods wouldn't work so well (which would also be true...).
In undergrad, I usually just went to class, took notes in a binder, read any
assigned reading, and reviewed everything once or twice in the day or two
before the exam, depending on the class. For medical school, though, I knew
that I would need a way to take in more information, organize it, and review it
more than once or twice.

After poking around the internet a bit, I settled on Microsoft’s OneNote to
take notes (if you have a PC, I highly recommend this program. If you have a Mac, I don't think it's available. I have heard good things about Evernote,
though, which is available on both platforms. That said, I prefer the
organizational structure of OneNote over Evernote – both are good programs,
however). This was a great way to 1) cut down on what I actually had to lug around 2) organize everything in one searchable, legible database (this latter point is important, as my handwriting is chicken-scratch) 3) and take more
notes much more quickly than I could write them, while also incorporating
various media as needed.

Below is a
great video describing how one can use OneNote in medical school. Everyone
might do things slightly differently, but this provides a good starting point.

Note: These aren't my videos, but I think they give a great overview of how to use OneNote and Anki.

If you have
a Mac, then I’d suggest checking out Evernote. Click here for a
basic overview of how to navigate Evernote.

If you used
paper in undergrad, like I did, you might think that you’d rather just keep
doing that. And that’s fine. But if you can, I’d really recommend switching to
a computer-based note-taking program. I have found it to be much faster and
more efficient. It allows me to pretty much have access to every note that I
have taken at all times, search the entire database, and sync it all in “the
cloud” so that, if I were to lose my laptop, I could be up and running on any
other computer in the time that it takes me to log in to SkyDrive. OneNote’s
built in screen-capture feature is also a very helpful tool that I use on a
daily basis.

So I had a
good way of taking notes. Great. But how would I review them? It is a common
refrain among medical students that you can expect to forget pretty much
everything you learn in the first couple of years. That may be true, but that
didn’t sit well with me. I’m sure most of what we learn is irrelevant, and that’s
fine, but not all of it is, and a large chunk of what we are learning we’ll
have to know for the boards. So I started to wonder if there was a way around
that…and found Anki.

Anki is
essentially a free flashcard program. You create the cards, review them, and
then the program will use a spaced-repetition algorithm that makes certain
cards due at various intervals, depending on how well you could recall the
information. (Update: I've written a brief Anki Q&A here.)

So, for
example, you make a card. Right after making the card, you review it. It’s
pretty easy, and you answer it correctly. The next day, the card is due again.
Again, you answered it pretty easily, so when Anki gives you the option of
choosing how well you recalled the information (generally something along the
lines of “again,” “hard,” “good,” or “easy,” with each option being associated
with a certain default time interval, like “10 minutes,” “2 days,” “3 days,” or
“4 days,” respectively), you select “good.” In three days, the card becomes due
again. If you again select "good," this time the time interval might be “5 days,”
and so on and so forth.

You can see
in the graph how this works out over the long term. After we learn something,
that knowledge immediately begins to decay. However, we can slow that knowledge
decay by exposing ourselves to that information again within a specified window
of time. Over time, this spaced review strengthens the memory of whatever it is
we are trying to recall. Sounds great… but the trick is to figure out when we
need to review the information. With physical flashcards, this quickly becomes
tedious (especially when you accumulate thousands of flashcards...). With notes, we might review those a few times before a test, but then
probably never really look at them again. With Anki, you don’t even have to
think about it. Anki does all of the work, and uses your answers (whether the
card is hard, good, or easy, for example) to create a personalized scheduling
algorithm for you.

So how do
you use this in school? There are many different ways to use it, but I’ll
briefly walk through how I’ve been using it. After lecture, I review my notes
and find important concepts, ideas, or minutia that I feel I need to know. It’s
important here to distinguish between things that only the professor would ever
ask, things that you might actually need to know for boards, and things that
you simply find interesting and/or helpful. For the most part, you only want to
make cards for things that fall into the last two categories. That said, you
can make cards for things in the first category and “suspend” them after the
test – that way, you reap the benefit, at least in the short term, of spaced repetition
while avoiding making your daily reviews in the long term too long.

I would
recommend trying to only make 20-50 cards a day (ideally), with an upper limit
of 100 new cards per day. When making new cards, there are some rules that you
should keep in mind about how to make efficient cards – you can (and should) read them here. If the cards that you make are junk, then Anki will not be
beneficial for you. Right after you make the cards, be sure to review them. Additionally, it can be helpful to tag the cards as you make
them – so, for example, if you are making cards about the upper extremity in anatomy,
you can tag them all under “upper_extremity” so that you could pull all of those
cards out later for a dedicated review, if you so desired. You can also tag by
source – for example, if you wanted to check what you are learning in your
classes against a gold-standard source like First Aid, you can tag any info
that is in First Aid with an appropriate tag so that you can review it later or
just to remind you not to suspend that card down the road. Again, while it
would normally be a waste of time to look at a source like First Aid in your
first year, with Anki this is no longer true, because you will actually
remember the information. Ideally, this will help you later when you do begin
to study for boards.

There are
also different types of cards you can make. You can make straight flashcards
(e.g. prompt on front, answer on back), you can use something called cloze
deletions, or you can use image occlusions. There are many other types of
cards, but these are the three types that I primarily use.

Cloze
deletion and image occlusion are powerful tools, and are perhaps best
illustrated by video. So below are some relevant videos that provide a short
introduction to how to use Anki and create those types of cards. I highly
recommend taking the time to watch them.

Now you’re
ready to get started. Go here to download
Anki, and here
to see the user manual if you have any other questions – although, if you’ve
watched the above videos, you should have a pretty good handle on things.

Finally, if
you ever have any problems with Anki, following the instructions in the video below
should fix them.

Once you’ve
made the cards, make it a point to review them daily. Just get it done – you’ll
be glad you did later. It might take a little more time up front to create the
cards and spend time reviewing them, but when it comes time for a test, I think
you’ll find that you’re a bit less stressed about it and are able to spend less
time trying to cram information in your head. Usually for tests I just
passively review my old notes once – quickly – just to get a “big picture” review
and to go over anything I specifically marked as something I should review (for
example, if I didn’t put something in Anki because it is important for the test
but for absolutely nothing else in life).

Also,
reviewing them can be done on the go. There is an Anki app for both Android (free)
and iPhone (not free, but worth it). For example, I start reviewing cards in
the morning while eating breakfast, while walking from the parking garage to
school (which would otherwise be a waste of 5-10 minutes, and during which time
I can get through a bunch of cards), in between classes, etc. This allows me to
sometimes be completely finished with my daily review by the time I get home,
or at least have a significant portion of it knocked out.

So that’s
OneNote and Anki. These are very powerful tools. There are, of course, many
ways to get through medical school, but, at least for me, these programs have
single-handedly gotten me this far, and I plan on continuing to use them throughout
the rest of school.

9 comments:

I actually use my laptop with OneNote to take notes in class. Works well for me - I can type much faster than I write, and I don't have to worry about deciphering my chicken scratch later. Also, my laptop has a touchscreen in case I really need to draw something or whatever, but that really doesn't come up a bunch. Hardly at all in the first year, actually. That said, there is a small chunk of my class that uses a variety of different tablets and seem to enjoy it.

The one caution I would have is that if you get an Apple product, OneNote doesn't have full functionality on those platforms, if that's what you are planning on using. Good luck.

I am really enjoying your blog and just picked up a surface pro3. I wanted to watch your videos on how to use anki and one note effectively however they are not there. Do you have them available on youtube or somehwere else? Thanks!

Just wanted to say thank you for the excellent advice and making my transition to medical school a little smoother! Fortunately, I stumbled upon this post before starting medical school. Having now completed several blocks, I refer anyone who asks me for study advice to this page.